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Work Stress

A meta-analysis of prospective cohort studies in 2013 found that an age- and sex-adjusted summary estimate of the relative risk for job strain on coronary heart disease is 1.35 (95% CI 1.2 to 1.5; Steptoe & Kivimäki, 2013).

Work stress in a psychosocial context is generally conceptualized in one of two ways: job strain and effort-reward imbalance. Job strain is defined as having a very demanding job coupled with little control over those demands. This definition comes from Karasek’s job demand- control model (1979), which follows the Lazarus & Folkman (1984) argument that psychosocial stress is experienced when situational demands on the person outweighs perceived available resources. Job strain is most frequently measured with the Job Content Questionnaire (Karasek et al., 1998). The second conceptualization of work stress comes from the effort-reward imbalance model in which stress arises when people put a lot of effort into their jobs for little reward (in the form of money, career growth, or recognition). The basis for this theory comes from the premise that a fair balance between the costs invested in cooperative activities and the gains received from those behaviors is a fundamental component to cooperative social exchanges, and in cases when there is failed reciprocity, negative emotions and other detrimental outcome will occur (Siegrist, 1996; Siegrist et al., 2004; Siegrist & Wahrendorf, 2016). Although many measures of work stress exist, the two most commonly used ones come from these prevailing theories of work stress and health.

Job Content Questionnaire

The job demand-control model proposes that there are two areas of work that contribute to work stress: job demands and job control, with heavy job demands and low decision latitude leading to higher job strain (Karasek, 1979). Demands involve workload, time pressure, and role conflict. Control is decision latitude, skill discretion, and decision authority. A job with both high demand and high control leads to active learning, motivation and skill development.

The original Job Content Questionnaire (Karasek et al., 1998) was 79 items that ask participants to self-report on experiences in their current job. The scale has since been used in considerably shorter iterations, including a 6-item version that is included in the Health and Retirement Study (along with several of the international HRS-family of studies). Example items for job strain are: My job requires working very fast; I am not asked to do an excessive amount of work; I have enough time to get the job done. An example item for job control is: I have very little freedom to decide how I do my work. For access to the scale visit the JCQ website. For psychometric information see Kopp et al. (2010).

Effort-Reward Imbalance Scale

The effort-reward imbalance model (Siegrist, 1996; Figure 1) states that inadequate reciprocity for expended effort results in negative emotionality and is stress-related physiological dysregulation. It suggests that people characterized by a motivational pattern of excessive work-related commitment and a high need for approval, are at high risk for distress from effort-reward imbalance. As a result of either exposing themselves to more demands at work or expending more effort than required, their expectations for rewards is higher (and often not met). Rewards include money, appreciation, and career or growth opportunities including job security. The model also states that the work role is vital to fulfilling an individual’s self-regulatory needs because work provides the opportunity to gain self-efficacy, self-esteem, and self-integration.

The theory that high effort-reward imbalance leads to physiological dysregulation associated with disease states is supported by empirical studies showing a link between effort-reward imbalance and objective measures of health like lower heart rate variability (Jarczok et al., 2013), coronary heart disease events (Dragano et al., 2017), type II diabetes incidence (Kumari, Head & Marmot, 2004), higher ambulatory blood pressure (Gilbert-Ouimet, Trudel, Brisson, Milot, & Vézina, 2014), depressive disorders (Rugulies, Aust, & Madsen, 2017), and sleep disturbances (Rugulies, Norborg, Sørensen, Knudsen, & Burr, 2009).

The Effort-Reward Imbalance Questionnaire (Siegrist et al., 2004) is a measure that captures three key components of the model – effort, reward, and tendency to ‘overcommit’). The scale was originally 22 items though a shorter 16-item version was developed and validated (Leineweber et al., 2010). Example items that capture effort component: I have constant time pressure due to a heavy workload; I have many interruptions and disturbances in my job. Example items that capture reward component: I receive the respect I deserve from my superiors; I experience adequate support in difficult situations. Example items that capture over-commitment: I get easily overwhelmed by time pressures at work; People close to me say I sacrifice too much for my job. In addition to the three components, a ratio is then computed from the two scales to quantify the imbalance of effort and reward at the individual level. For further scoring details and psychometric information see Montano et al. (2016) and Siegrist, Li, Montano (2014). For scale items see here.

An important note here is that these work stress models were developed in the industrial era of the 1960s-1980s, when people worked in relatively secure jobs in factories and offices. In the current economic environment, work cultures are different – people often work outside the office, industrial jobs are rarer, job security is a big issue, people move from one job to another, work is not confined to an 8 hour day for many people, work-life balance is a problem, to name a few changes. New models of work stress and new measures may need to be developed to capture these changes to modern life.


Figure 1: The effort-reward imbalance paradigm, and aspects that maintain imbalance (Siegrist, 2012)


Author(s) and Reviewer(s):

Prepared by Alexandra Crosswell, PhD. Reviewed by Johannes Siegrist, PhD, and Andrew Steptoe, MA, DPhil, DSc, FMedSci. If you have any comments on these measures, email Version date: August 2018.


Dragano, N., Siegrist, J., Nyberg, S. T., Lunau, T., Fransson, E. I., Alfredsson, L., … Kivimäki, M. (2017). Effort-Reward Imbalance at Work and Incident Coronary Heart Disease: A Multicohort Study of 90,164 Individuals. Epidemiology, 28(4), 619–626.

Gilbert-Ouimet, M., Trudel, X., Brisson, C., Milot, A., & Vézina, M. (2014). Adverse effects of psychosocial work factors on blood pressure: systematic review of studies on demand-control-support and effort-reward imbalance models. Scandinavian Journal of Work, Environment & Health, 40(2), 109–32.

Jarczok, M. N., Jarczok, M., Mauss, D., Koenig, J., Li, J., Herr, R. M., & Thayer, J. F. (2013). Autonomic nervous system activity and workplace stressors—A systematic review. Neuroscience & Biobehavioral Reviews, 37(8), 1810–1823.

Karasek, R. (1979). Job Demands, Job Decision Latitude, and Mental Strain: Implications for Job Redesign. Administrative Science Quarterly, 24(2), 285.

Karasek, R., Brisson, C., Kawakami, N., Houtman, I., Bongers, P., & Amick, B. (1998). The Job Content Questionnaire (JCQ): An instrument for internationally comparative assessments of psychosocial job characteristics. Journal of Occupational Health Psychology, 3(4), 322–355.

Kivimäki, M., Nyberg, S., Batty, G., Fransson, E. I., Heikkilä, K., Alfredsson, L., … Theorell, T. (2012). Job strain as a risk factor for coronary heart disease: a collaborative meta-analysis of individual participant data. The Lancet, 6736(12), 1–9.

Kopp, M. S., Thege, B. K., Balog, P., Stauder, A., Salavecz, G., Rózsa, S., … Ádám, S. (2010). Measures of stress in epidemiological research. Journal of Psychosomatic Research, 69(2), 211–225.

Lazarus, R., & Folkman, S. (1984). Coping and Adaptation. In W. D. Gentry (Ed.), The Handbook of Behavioral Medicine (pp. 282–325). The Guilford Press.

Leineweber, C., Wege, N., Westerlund, H., Theorell, T., Wahrendorf, M., & Siegrist, J. (2010). How valid is a short measure of effort-reward imbalance at work? A replication study from Sweden. Occupational and Environmental Medicine, 67(8), 526–31.

Montano, D., Li, J., & Siegrist, J. (2016). The Measurement of Effort-Reward Imbalance (ERI) at Work (pp. 21–42). Springer, Cham.

Nyberg, S. T., Fransson, E. I., Heikkilä, K., Alfredsson, L., Casini, A., Clays, E., … Kivimäki, M. (2013). Job Strain and Cardiovascular Disease Risk Factors: Meta-Analysis of Individual-Participant Data from 47,000 Men and Women. PLoS ONE, 8(6), e67323.

Rugulies, R., Aust, B., & Madsen, I. E. (2017). Effort–reward imbalance at work and risk of depressive disorders. A systematic review and meta-analysis of prospective cohort studies. Scandinavian Journal of Work, Environment & Health, 43(4), 294–306.

Rugulies, R., Norborg, M., Sørensen, T. S., Knudsen, L. E., & Burr, H. (2009). Effort–reward imbalance at work and risk of sleep disturbances. Cross-sectional and prospective results from the Danish Work Environment Cohort Study. Journal of Psychosomatic Research, 66(1), 75–83.

Siegrist, J. (1996). Adverse health effects of high-effort/low-reward conditions. Journal of Occupational Health Psychology, 1(1), 27–41.

Siegrist, J., Li, J., & Montano, D. (2014). Psychometric properties of the effort-reward imbalance questionnaire.

Siegrist, J., Starke, D., Chandola, T., Godin, I., Marmot, M., Niedhammer, I., & Peter, R. (2004). The measurement of effort-reward imbalance at work: European comparisons. Social Science and Medicine, 58(8), 1483–1499.

Siegrist, J., & Wahrendorf, M. (2016). Work Stress and Health in the Globalized Economy: The Model of Effort-Reward Imbaance. Springer International Publishing.

Steptoe, A., & Kivimäki, M. (2013). Stress and cardiovascular disease: An update on current knowledge. Annual Review of Public Health, 34(1), 337–354.

Epidemiological studies and meta-analyses over the past several decades have clearly shown associations between high psychosocial work stress and worse physical health, including cardiovascular disease outcomes and mortality (e.g. Kivimäki et al., 2012; Nyberg et al., 2013).

Figure 1_0 work strain.png
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